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Née M, Avalos M, Luxcey A, Contrand B, Salmi LR, Fourrier-Réglat A, Gadegbeku B, Lagarde E, Orriols L. Prescription medicine use by pedestrians and the risk of injurious road traffic crashes: A case-crossover study. PLoS Med 2017; 14:e1002347. [PMID: 28719606 PMCID: PMC5515401 DOI: 10.1371/journal.pmed.1002347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND While some medicinal drugs have been found to affect driving ability, no study has investigated whether a relationship exists between these medicines and crashes involving pedestrians. The aim of this study was to explore the association between the use of medicinal drugs and the risk of being involved in a road traffic crash as a pedestrian. METHODS AND FINDINGS Data from 3 French nationwide databases were matched. We used the case-crossover design to control for time-invariant factors by using each case as its own control. To perform multivariable analysis and limit false-positive results, we implemented a bootstrap version of Lasso. To avoid the effect of unmeasured time-varying factors, we varied the length of the washout period from 30 to 119 days before the crash. The matching procedure led to the inclusion of 16,458 pedestrians involved in an injurious road traffic crash from 1 July 2005 to 31 December 2011. We found 48 medicine classes with a positive association with the risk of crash, with median odds ratios ranging from 1.12 to 2.98. Among these, benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs were among the 10 medicines most consumed by the 16,458 pedestrians. Study limitations included slight overrepresentation of pedestrians injured in more severe crashes, lack of information about self-medication and the use of over-the-counter drugs, and lack of data on amount of walking. CONCLUSIONS Therapeutic classes already identified as impacting the ability to drive, such as benzodiazepines and antihistamines, are also associated with an increased risk of pedestrians being involved in a road traffic crash. This study on pedestrians highlights the necessity of improving awareness of the effect of these medicines on this category of road user.
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Affiliation(s)
- Mélanie Née
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
- * E-mail:
| | - Marta Avalos
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team Biostatistique, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université Bordeaux, Bordeaux, France
| | - Audrey Luxcey
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Benjamin Contrand
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Louis-Rachid Salmi
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
- Service d’Information Médicale, Pôle de Santé Publique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Annie Fourrier-Réglat
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université Bordeaux, Bordeaux, France
- Pharmacologie Medicale, Pôle de Santé Publique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Centre d’Investigation Clinique Bordeaux, INSERM CIC 1401, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Blandine Gadegbeku
- Université de Lyon, Lyon, France
- UMRESTTE, UMR T9405, l’Institut Français des Sciences et Technologies des Transports, de l’Aménagement et des Réseaux (IFSTTAR), Bron, France
- UMRESTTE, Université Lyon 1, Lyon, France
| | - Emmanuel Lagarde
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Ludivine Orriols
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
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Shilo Y, Pypendop BH, Barter LS, Epstein SE. Thymoma removal in a cat with acquired myasthenia gravis: a case report and literature review of anesthetic techniques. Vet Anaesth Analg 2012; 38:603-13. [PMID: 21988817 DOI: 10.1111/j.1467-2995.2011.00648.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED HISTORY AND PRESENTATION: A 12 year old, 4.2 kg, domestic long hair, castrated male cat was presented with regurgitation, inability to retract the claws, general weakness, cervical ventroflexion and weight loss. A thymic mass was evident on radiographs. Acetylcholine receptor antibody titer was positive for acquired myasthenia gravis (MG). Thymectomy via midline sternotomy was scheduled. ANESTHETIC MANAGEMENT: Oxymorphone and atropine were administered subcutaneously as premedication, and anesthesia was induced with etomidate and diazepam given intravenously to effect. The cat's trachea was intubated and anesthesia was maintained with isoflurane in oxygen, and continuous infusions of remifentanil and ketamine. Epidural analgesia with preservative-free morphine was administered prior to surgery. Postoperative analgesia was provided by oxymorphone subcutaneously, interpleural bupivacaine, and fentanyl infusion. Postoperative complications included airway obstruction, hypoxemia and hypercapnia. FOLLOW-UP The cat was discharged 3 days after surgery. Discharge medications included pyridostigmine and prednisone. Nine days after surgery, the cat had a significant increase in its activity level, and medications were discontinued. Histopathologically, the mass was consistent with a thymoma. Approximately 6 weeks later the cat became weak again and pyridostigmine and prednisone administration was resumed. CONCLUSION The perioperative management of patients with MG for transsternal thymectomy is a complex task. The increased potential for respiratory compromise requires the anesthesiologist to be familiar with the underlying disease state, and the interaction of anesthetic and non-anesthetic drugs with MG. Careful monitoring of ventilation and oxygenation is indicated postoperatively.
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Affiliation(s)
- Yael Shilo
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
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